Report cards frequently display large amounts of complex information that consumers have difficulty understanding, decreasing the likelihood that consumers will use the information to make informed provider choices. In response to this problem, report cards are increasingly using summary or composite measures of quality with the goal of increasing consumer comprehension of and response to report cards. Yet it is unknown whether this approach has been successful or if there are tradeoffs to using these simplified measures. The Centers for Medicare and Medicaid Services (CMS) recently switched from rating nursing homes on individual quality measures to using a composite "star rating" on Nursing Home Compare, its web-based guide that publicly rates all Medicare- or Medicaid-certified nursing homes. Despite the significant resources that have been invested in the use of composite measures, it is unknown how consumers have responded to them. On one hand, the easier-to-navigate star rating system may be more effective in engaging consumers and influencing their choice of nursing homes. On the other hand, the star rating system may oversimplify patients'choice, as it combines short- and long-stay clinical quality measures and combines clinical quality measures with staffing and regulatory deficiencies. It thus may limit patients'ability to match with nursing homes that best suit their needs.
Our specific aims are 1) To evaluate the effect of composite vs. individual quality measures on consumer's nursing home choice, 2) To evaluate the effect of composite vs. individual quality measures on matching of consumers to nursing homes, and 3) To assess qualitatively the how consumers interpret and use composite vs. individual ratings in public reporting of nursing home quality. To address these aims we propose to use mixed methods, including a long panel (1998-2010) of the nursing home Minimum Data Set merged with facility characteristics for Aims 1 and 2, and semi-structured interviews for Aim 3. The goal of this research is to identify ways to improve how the information is conveyed in nursing home report cards and thus increase consumers'effective use of this information.
Although public report cards are intended to improve consumers'choice of providers, they are often not used by consumers, limiting their effectiveness in improving health care quality. This project tests the effect of one commonly used method to improve consumer use of report card information-the use of composite measures. By testing consumer response to composite measures of nursing home quality this project will directly inform future efforts to create more effective report cards.